Rx of achalasia

Pharyngeal pouch pathophysiology

Outpouching of oesophagus between upper boarder of cricopharyngeus muscle and lower boarder of inferior constrictor of pharynx Weak area called Killian’s dehiscence. Defect usually occurs posteriorly but swelling usually bulges to left side of neck. Food debris → pouch expansion → oesophagealcompression → dysphagia.

Complications of gastric cancer

Ix for gastric cancer

URGENT OGD + biopsy - CXR/USS/ CT - metsStaging - CT CAP

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Complications of gastrectomy

- death- anastomotic leak - poor QoL- Vit B12 def- re-operation

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describe the excretion of bilirubin

Hb → unconjugated to BR by splenic macrophages uBR → cBR by BR-UDP-glucuronyl transferase in liver Secreted in bile then cBR → urobilinogen (colourless) Some urobilinogen is reabsorbed, returned to liver and re-excreted into bile. Some reabsorbed urobilinogen is excreted into the urine The urobilinogen that remains in the GIT is converted to stercobilin (brown) and excreted.

Complications of gallstones

In the CBD1. Obstructive jaundice2. Pancreatitis3. Cholangitis

In the Gut1. Gallstone ileus

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Pathogenesis and presentation of biliary colic

Gallbladder spasm against a stone impacted in the neck of the gallbladder – Hartmann’s Pouch.

 RUQ pain radiating → back (scapular region) Assoc. c¯ sweating, pallor, n/v Attacks may be ppted. by fatty food and last <6h o/e may be tenderness in right hypochondrium ± jaundice if stones passes in to CB

Surgical management of. bowel obstruction

SBO: adhesiolysis

Types of stoma

Colostomy - flush to skin; LIF- loop --> entire loop of colon exteriorised and both proximal and distal end open into common stoma opening and are not transected- end --> created from proximal end of colon, distal end stapled/ sewn shut and remains as blind pouch